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Protocol

Royal Alexandra Hospital Chest Pain Assessment Unit (CPAU)

If HEART Score 5 page 2nd on 56228 to arrange admission.

N.B 2nd on may decide to admit to CPAU if bed not immediately available in CCU

Out of hours (17.30 to 08.30) follow current pathway and phone 2nd on.

All CPAU admissions to be discussed with ED senior who may decide to admit to CPAU irrespective of HEART Score

|HEART score for chest pain patients |

|History |Highly suspicious |2 | |

| |Moderately suspicious |1 | |

| |Slightly suspicious |0 | |

|ECG |Significant ST-depression |2 | |

| |Non specific repolarization disturbance |1 | |

| |Normal |0 | |

|Age |≥ 65 year |2 | |

| |45 – 65 year |1 | |

| |≤ 45 year |0 | |

|Risk factors |≥ 3 risk factors or history of atherosclerotic disease |2 | |

| |1 or 2 risk factors |1 | |

| |No risk factors known |0 | |

|Troponin (In ED assume |≥ 3x normal limit |2 | |

|normal unless result | | | |

|available due to delay) | | | |

| |1-3x normal limit |1 | |

| |≤ normal limit |0 | |

|Total | |

History

If the history is regarded as slightly suspicious or non-specific = 0 point.

If the history is regarded as moderately suspicious in that

it contains both nonspecific and suspicious elements = 1 point

If the history is regarded as highly suspicious = 2 points.

A highly suspicious history should contain mainly elements, such as middle- or left-sided, heavy chest pain, radiation, and/or definite relief of symptoms by GTN

ECG scoring. Where possible compare with previous ECG on MUSE.

Score is not additive use highest score

Normal ECG = 0 points.

Repolarisation change + no significant ST-seg. depression/elevation = 1 point.

Bundle branch block, pacemaker rhythm, typical abnormalities

indicative of left ventricular hypertrophy = 1 point

Repolarisation abnormalities probably caused by digoxin use = 1 point

Unchanged repolarisation disturbances = 1 point

Significant ST-segment depressions or elevations

in absence of a bundle branch block,

left ventricular hypertrophy, or the use of digoxin = 2 points

T wave inversion (outwith v1+v2) not known to be established = 2 points

Findings of infarction or ischemia not known to be old = 2 points

Risk Factors

currently treated diabetes mellitus, current or recent (30), or a history of significant atherosclerosis (coronary revascularization, myocardial infarction, stroke, or peripheral arterial disease, irrespective of the risk factors for coronary artery disease).

no risk factors at all = 0 points

1 or 2 risk factors, = 1 point

3 or more risk factors or had a history of significant atherosclerosis = 2 points

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Date:

Time 24 hour clock :

Insert Patient Label here

Inclusions to be met for admission : Please Circle

The principal symptom should be “chest pain” of possible cardiac origin Y

Patient must be pain free Y

HEART Score 5 but sanctioned by ED Senior Y

Exclusions – all must be NO: Please Circle

Ongoing Pain, or required morphine to relieve pain N

STEMI N

Reasonable suspicion of significant non-cardiac diagnosis N

NEWS >3 (discuss with senior if chronic) N

Complex co-morbidities/frailty likely necessitating admission N

Co-existing conditions that likely necessitate admission N

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Pregnancy N

Process: TICK

Clerk on usual medical proforma [pic]

Send bloods – AMED including initial Troponin [pic]

Send for CXR on way to CPAU [pic] There is no need to wait for Troponin result

Insert Patient Label here

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